Basic Information
| Provider Information | |||||||||
| NPI: | 1972552115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENGLEWOOD PAIN CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 ENGLE ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076311823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018716073 | ||||||||
| FaxNumber: | 2018710619 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 ENGLE ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076311808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018710673 | ||||||||
| FaxNumber: | 2018710619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHANDER | ||||||||
| AuthorizedOfficialFirstName: | ARYEH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2018716073 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | DE0144 | 01 | NJ | RAILROAD MEDICARE | OTHER | 8432601 | 05 | NJ | MEDICAID |